本文選題：變應(yīng)性鼻炎　切入點：聚焦超聲　出處：《中國醫(yī)科大學》2010年碩士論文

【摘要】： 目的 1、對比觀察聚焦超聲治療術(shù)與布地奈德鼻噴劑在治療常年性變應(yīng)性鼻炎中的療效。 2、針對變應(yīng)性鼻炎伴鼻中隔偏曲、下鼻甲肥大且鼻塞明顯的患者,分析手術(shù)治療的療效,并比較不同手術(shù)方法的效果。 3、分析遼寧地區(qū)常年性持續(xù)性中重度變應(yīng)性鼻炎患者變應(yīng)原的種類和分布情況。 4、分析常年性持續(xù)性中重度變應(yīng)性鼻炎患者的鼻炎相關(guān)生活質(zhì)量狀況,評價不同指標間的相關(guān)性,比較不同治療方法在治療前后生活質(zhì)量的改善情況。 方法和材料 將符合納入標準的65例患者按鼻腔結(jié)構(gòu)是否異常分成兩部分。第一部分,鼻腔結(jié)構(gòu)正常者20例,均接受聚焦超聲治療,作為手術(shù)組；選取同期接受布地奈德噴鼻治療的符合入選條件的同等數(shù)量患者作為藥物組。觀察期3個月。記錄癥狀評分,VAS視覺評分和生活質(zhì)量評分。第二部分,伴有鼻中隔偏曲、下鼻甲肥大患者45例,分為三組,分別行A：鼻中隔偏曲矯正、下鼻甲外移部分切除治療術(shù)；B：鼻中隔偏曲矯正、下鼻甲聚焦超聲治療術(shù)；C：鼻中隔偏曲矯正、下鼻甲外移部分切除聯(lián)合聚焦超聲治療術(shù)。完成6個月隨訪,記錄癥狀評分。所有入選患者均于門診行皮膚點刺試驗(SPT),并初步分析變應(yīng)原檢查結(jié)果。入院時、隨訪時記錄生活質(zhì)量評分,并分析結(jié)果。 結(jié)果 1、在鼻腔結(jié)構(gòu)正常的患者中,手術(shù)組的各項評分在術(shù)后的各次隨訪中均優(yōu)于藥物組。 2、在伴有鼻中隔偏曲、下甲肥大、鼻塞明顯的患者中,三種不同的手術(shù)方法在術(shù)后6個月的評分均比術(shù)前有顯著的改善,C組(鼻中隔偏曲矯正、下鼻甲外移部分切除聯(lián)合聚焦超聲治療術(shù))的評分最好。B組(鼻中隔偏曲矯正、下鼻甲聚焦超聲治療術(shù)),鼻堵項的評分較差。A組(鼻中隔偏曲矯正、下鼻甲外移部分切除治療術(shù))在噴嚏、鼻涕、鼻癢癥狀上的評分均不如B組、C組。 3、39例皮膚點刺試驗分析結(jié)果：粉塵螨19例、屋塵螨20例、豚草16例、艾蒿19例、花粉1例、貓毛2例、德國小蠊2例、霉菌1例。 4、生活質(zhì)量相關(guān)性分析結(jié)果：缺乏良好睡眠和鼻堵癥狀評分顯著相關(guān)；睡眠總分和非鼻-結(jié)膜炎癥狀總分顯著相關(guān)；缺乏良好睡眠和工作效率下降顯著相關(guān)；變應(yīng)性鼻炎癥狀對日�；顒佑绊懙姆植己统潭确治鼋Y(jié)果：工作、社交活動、吸塵器打掃房間、做家務(wù)依次是選擇最多的日�；顒佣畈�、養(yǎng)寵物、散步、吸塵器打掃房間依次是選擇分數(shù)最高的日�；顒�。 結(jié)論 1、聚焦超聲治療對比藥物治療,起效快、短期療效顯著。 2、對伴有鼻腔結(jié)構(gòu)異常的變應(yīng)性鼻炎患者,手術(shù)治療可以明顯改善癥狀；但聚焦超聲對下鼻甲的減容效果不如下鼻甲部分切除術(shù)。鼻中隔偏曲矯正、下鼻甲外移部分切除聯(lián)合聚焦超聲治療術(shù)這種手術(shù)療法效果最好。 3、塵螨是遼寧地區(qū)變應(yīng)性鼻炎的首位過敏原。 4、相關(guān)性分析提示鼻部癥狀可能是影響睡眠質(zhì)量的主要原因,睡眠質(zhì)量可以影響非鼻-結(jié)膜炎癥狀。
[Abstract]:objective
1, the efficacy of focused ultrasound therapy and budesonide nasal spray in the treatment of perennial allergic rhinitis was compared.
2, for allergic rhinitis and deviation of nasal septum, inferior turbinate and nasal congestion in patients with obvious curative effect analysis of surgical treatment, and the effect of different surgical procedures.
3, analysis of the types and distribution of allergens in patients with perennial persistent moderate and severe allergic rhinitis in Liaoning.
4, we analyzed the status of rhinitis related quality of life in perennial persistent moderate severe allergic rhinitis, evaluated the correlation between different indicators, and compared the improvement of quality of life before and after treatment with different treatments.
Methods and materials
Will meet the inclusion criteria of 65 cases of patients according to whether the abnormal nasal structure is divided into two parts. The first part, 20 cases of normal nasal structure, were treated with focused ultrasound therapy, were selected as operation group; treatment with budesonide nasal spray eligible patients with the same number as drug group. The observation period was 3 months. The symptoms recorded score, VAS score and visual quality of life score. In the second part, with deviation of nasal septum, 45 cases of inferior turbinate hypertrophy patients were divided into three groups, respectively: A nasal septum and inferior turbinate outfracture partial resection; B: nasal septum, inferior turbinate focused ultrasound therapy; C the nasal septum, partial resection combined with focused ultrasound treatment of inferior turbinate outfracture. Completed 6 months of follow-up, record the symptom score. All patients in the outpatient department for skin prick test (SPT), and preliminary analysis of allergen detection At the time of admission, the quality of life was recorded and the results were analyzed.
Result
1, among the patients with normal nasal structure, the scores of the operation group were better than those in the drug group after all the postoperative follow-up.
2, in patients with deviation of nasal septum, inferior turbinate hypertrophy, nasal congestion significantly in patients with three different surgical methods in 6 months after operation were significantly improved compared with the preoperative group (C, nasal septum, inferior turbinate outfracture resection combined with focused ultrasound therapy the best score) group.B (nasal septum, inferior turbinate focused ultrasound therapy), nasal blockage scores. Group.A (the nasal septum and inferior turbinate outfracture part resection) in the nose, sneezing, nasal itching symptoms were less than that of B group, C group.
Results 3,39 cases of skin prick test: 19 cases of 20 cases of dust mites, house dust mite, ragweed mugwort in 16 cases, 19 cases, 1 cases of 2 cases of pollen, cat hair, 2 cases of Blattella germanica, 1 cases of fungus.
4, quality of life correlation analysis results: the lack of good sleep and nasal symptom scores were significantly related to blocking was significantly related to total sleep; and non - nasal conjunctivitis symptoms score; the lack of good sleep and work efficiency decreased significantly; the distribution and degree of influence analysis results of allergic rhinitis symptoms on daily activities: work, social activities, cleaner clean the room and do the housework in turn is to choose the most daily activities and mowing, pets, a vacuum cleaner to clean the room in turn is to choose the highest score of the daily activities.
conclusion
1, focused ultrasound treatment compared with drug treatment, quick effect, short term curative effect.
2, the allergic rhinitis patients with structural abnormality of nasal cavity, surgical treatment can significantly improve the symptoms; but focused ultrasound on the inferior turbinate reduction effect than inferior turbinectomy. The nasal septum, partial resection combined with focused ultrasound therapy the best surgical treatment of inferior turbinate outfracture.
3, dust mites are the first anaphylaxis in the allergic rhinitis in Liaoning.
4, correlation analysis suggests that nasal symptoms may be the main factors affecting the quality of sleep, and the quality of sleep can affect the symptoms of non nasal conjunctivitis.

【學位授予單位】：中國醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2010
【分類號】：R765.21

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